Shoulder Problems and Injuries

Topic Overview

Minor shoulder problems, such as sore muscles and aches and pains,
are common. Shoulder problems develop from everyday wear and tear, overuse, or
an injury. They can also be caused by the natural process of aging.

Your shoulder joints move every time you move your arms. To better
understand shoulder problems and injuries, you may want to review the anatomy
and function of the
shoulder. The shoulder is a ball-and-socket joint with
three main bones: the upper arm bone (humerus), collarbone (
clavicle ), and shoulder blade (scapula). These
bones are held together by muscles,
tendons, and
ligaments. The shoulder joint has the greatest
range of motion of any joint in the body. Because of
this mobility, the shoulder is more likely to be injured or cause problems. The
acromioclavicular (AC) joint , which lies over the top
of the shoulder, is also easily injured.

Shoulder problems can be
minor or serious. Symptoms may include pain, swelling, numbness, tingling,
weakness, changes in temperature or color, or changes in your range of motion.
Shoulder injuries most commonly occur during sports activities, work-related
tasks, projects around the home, or falls. Home treatment often can help
relieve minor aches and pains.

Sudden (acute) injury

Injuries are the most common
cause of shoulder pain.

A sudden (acute) injury may occur from a
fall on an outstretched arm, a direct blow to the shoulder, or abnormal
twisting or bending of the shoulder. Pain may be sudden and severe. Bruising
and swelling may develop soon after the injury. If nerves or blood vessels have
been injured or pinched during the injury, the shoulder, arm, or hand may feel
numb, tingly, weak, or cold, or it may look pale or blue. Acute injuries
include:

Bruises (
contusions), which occur when small
blood vessels under the skin tear or rupture, often from a twist, bump, or
fall. Blood leaks into tissues under the skin and causes a black-and-blue color
that often turns purple, red, yellow, and green as the bruise
heals.

Injuries to the tough, ropy fibers (ligaments) that
connect bone to bone and help stabilize the shoulder joints (
sprains).

Injuries to the tough, ropy
fibers that connect muscle to bone (tendons).

Separation of the shoulder , which occurs when the
outer end of the collarbone (clavicle) separates from the end (acromion) of the
shoulder blade because of torn ligaments. This injury occurs most often from a
blow to a shoulder or a fall onto a shoulder or outstretched hand or
arm.

Damage to one or more of the four tendons that cover the
shoulder joint (
torn rotator cuff), which may occur from a direct blow
to or overstretching of the tendon.

Broken bones (
fractures). A break may occur when a bone is twisted,
struck directly, or used to brace against a fall.

Pulling or
pushing bones out of their normal relationship to the other bones that make up
the shoulder joint (
subluxation or
dislocation).

Overuse injuries

You may not recall having a specific
injury, especially if symptoms began gradually or during everyday activities.
Overuse injuries occur when too much stress is placed on a joint or other
tissue, often by overdoing an activity or through repetition of an activity.
Overuse injuries include:

Inflammation of the sac of fluid that cushions
and lubricates the joint area between one bone and another bone, a tendon, or
the skin (
bursitis).

Inflammation of the tough,
ropy fibers that connect muscles to bones (
tendinitis).
Bicipital tendinitis is an inflammation of one of the
tendons that attach the muscle (biceps) on the front of the upper arm bone
(humerus) to the shoulder joint. The inflammation usually occurs along the
groove (bicipital groove) where the tendon passes over the humerus to attach
just above the shoulder joint.

A
frozen shoulder , which is a condition that limits
shoulder movement and may follow an injury.

Overhead arm
movements, which may cause tendons to rub or scrape against a part of the
shoulder blade called the acromion. This rubbing or scraping may lead to
abrasion or inflammation of the
rotator cuff tendons (also called
impingement syndrome ).

Other causes of shoulder symptoms

Overuse and acute
injuries are common causes of shoulder symptoms. Less common causes of shoulder
symptoms include:

Many things can affect how your body responds to a symptom and what kind
of care you may need. These include:

Your age. Babies and older
adults tend to get sicker quicker.

Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart
disease, you may need to pay closer attention to certain symptoms and seek care
sooner.

Medicines you take. Certain
medicines, herbal remedies, and supplements can cause symptoms or make them
worse.

Recent health events, such as surgery
or injury. These kinds of events can cause symptoms afterwards or make them
more serious.

Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug
use, sexual history, and travel.

Certain health conditions and medicines weaken the immune system's ability to fight off infection and
illness. Some examples in adults are:

Diseases such as diabetes, cancer, heart disease,
and HIV/AIDS.

Long-term alcohol and drug
problems.

Steroid medicines, which may be used to treat a variety
of conditions.

Chemotherapy and radiation therapy for
cancer.

Other medicines used to treat autoimmune
disease.

Medicines taken after organ transplant.

Not
having a spleen.

Symptoms of infection may
include:

Increased pain, swelling, warmth, or redness in or
around the area.

Red streaks leading from the area.

Pus draining from the area.

A fever.

When an area turns blue, very pale, or cold, it can mean that there has been a sudden change in the blood
supply to the area. This can be serious.

There are other reasons
for color and temperature changes. Bruises often look blue. A limb may turn
blue or pale if you leave it in one position for too long, but its normal color
returns after you move it. What you are looking for is a change in how the area
looks (it turns blue or pale) and feels (it becomes cold to the touch), and
this change does not go away.

Try Home Treatment

You have answered all the questions. Based on your answers, you may be
able to take care of this problem at home.

Try home treatment to relieve the
symptoms.

Call your doctor if symptoms get worse or you have any
concerns (for example, if symptoms are not getting better as you would expect).
You may need care sooner.

Severe pain (8 to 10): The
pain is so bad that the baby cannot sleep, cannot get comfortable, and cries
constantly no matter what you do. The baby may kick, make fists, or
grimace.

Moderate pain (5 to 7): The baby is
very fussy, clings to you a lot, and may have trouble sleeping but responds
when you try to comfort him or her.

Mild pain (1 to 4): The baby is a little fussy and clings to you a little but responds
when you try to comfort him or her.

With severe bleeding, any of these may
be true:

Blood is pumping from the wound.

The
bleeding does not stop or slow down with pressure.

Blood is quickly soaking through bandage after bandage.

With moderate bleeding, any of these may
be true:

The bleeding slows or stops with pressure but
starts again if you remove the pressure.

The blood may soak through
a few bandages, but it is not fast or out of control.

With mild bleeding, any of these may be
true:

The bleeding stops on its own or with
pressure.

The bleeding stops or slows to an ooze or trickle after
15 minutes of pressure. It may ooze or trickle for up to 45 minutes.

Major trauma is any event that can
cause very serious injury, such as:

A fall from more than
10 ft (3.1 m) [more than
5 ft (1.5 m) for children under
2 years and adults over 65].

A car crash in which any vehicle
involved was going more than
20 miles (32 km) per
hour.

Any event that causes severe bleeding that you cannot
control.

Any event forceful enough to badly break a bone.

Pain in adults and older children

Severe pain (8 to 10): The pain
is so bad that you can't stand it for more than a few hours, can't sleep, and
can't do anything else except focus on the pain.

Moderate pain (5 to 7): The pain is bad enough to disrupt your
normal activities and your sleep, but you can tolerate it for hours or days.
Moderate can also mean pain that comes and goes even if it's severe when it's
there.

Mild pain (1 to 4): You notice the pain,
but it is not bad enough to disrupt your sleep or activities.

Symptoms of a heart attack may
include:

Chest pain or pressure, or a strange feeling in the chest.

Sweating.

Shortness of
breath.

Nausea or vomiting.

Pain, pressure, or a
strange feeling in the back, neck, jaw, or upper belly, or in one or both
shoulders or arms.

Lightheadedness or sudden
weakness.

A fast or irregular heartbeat.

The more of these symptoms you have, the more likely it is that
you're having a heart attack. Chest pain or pressure is the most common
symptom, but some people, especially women, may not notice it as much as other
symptoms. You may not have chest pain at all but instead have shortness of breath, nausea, numbness,
tingling, or a strange feeling in your chest or other areas.

Shock is a life-threatening condition that may occur quickly
after a sudden illness or injury.

Symptoms of shock in a child may include:

Passing out.

Being very sleepy or hard
to wake up.

Not responding when being touched or talked to.

Breathing much faster than usual.

Acting confused.
The child may not know where he or she is.

Shock is a life-threatening condition that may quickly occur
after a sudden illness or injury.

Symptoms of shock (most of which will be present) include:

Passing out.

Feeling very dizzy or
lightheaded, like you may pass out.

Feeling very weak or having
trouble standing.

Not feeling alert or able to think clearly. You
may be confused, restless, fearful, or unable to respond to questions.

Pain in children 3 years and older

Severe pain (8 to 10): The pain
is so bad that the child can't stand it for more than a few hours, can't sleep,
and can't do anything else except focus on the pain. No one can tolerate severe
pain for more than a few hours.

Moderate pain (5 to 7): The pain is bad enough to disrupt the child's normal activities and
sleep, but the child can tolerate it for hours or days.

Mild pain (1 to 4): The child notices and may complain of the pain,
but it is not bad enough to disrupt his or her sleep or activities.

Call 911 Now

Based on your answers, you need
emergency care.

Call911or other emergency services now.

Put direct, steady pressure on the
wound until help arrives. Keep the area raised if you can.

Seek Care Today

Based on your answers, you may need care soon. The
problem probably will not get better without medical care.

Call your doctor today to discuss the symptoms
and arrange for care.

If you cannot reach your doctor or you don't
have one, seek care today.

Call 911 Now

After you call
911 , the operator may tell you to chew 1 adult-strength (325 mg) or 2
to 4 low-dose (81 mg) aspirin. Wait for an ambulance. Do not try to drive yourself.

Call 911 Now

Based on your answers, you need
emergency care.

Call911or other emergency services now.

Home Treatment

First aid for a suspected broken bone

Control bleeding. Apply steady, direct
pressure for a full 15 minutes. Use a clock—15 minutes can seem like a long
time. Resist the urge to peek after a few minutes to see whether bleeding has
stopped. If blood soaks through the cloth, apply another one without lifting
the first. If there is an object in the wound, apply pressure around the
object, not directly over it.

Remove all rings or bracelets. It may
be difficult to remove the jewelry after swelling develops.

If a
bone is sticking out of the skin, do not try to push it back into the skin.
Cover the area with a clean bandage.

Splint care

If a cast or splint is applied, it is
important to keep it dry and to try to move the uninjured parts of your limb as
normally as possible to help maintain muscle strength and tone. Your doctor
will give you instructions on how to
care for your cast or splint .

Home treatment for minor symptoms

Home treatment may
help relieve pain, swelling, and stiffness.

If your injury does
not require an evaluation by a doctor, you may be able to use home treatment to
help relieve pain, swelling, and stiffness. It may take up to 6 weeks or longer
before your symptoms are gone.

Rest and protect an
injured or sore area. Stop, change, or take a break from any activity that may
be causing your pain or soreness.

Ice will
reduce pain and swelling. Apply
ice or cold packs immediately to prevent or minimize swelling. Apply the ice
or cold pack for 10 to 20 minutes, 3 or more times a day.

For the first 48 hours after an injury,
avoid things that might increase swelling, such as hot showers, hot tubs, hot
packs, or alcoholic beverages.

After 48 to 72 hours, if swelling is
gone, apply
heat and begin
gentle exercise with the aid of moist heat to help
restore and maintain flexibility. Some experts recommend alternating between
heat and cold treatments.

Wear a
sling for the first 48 hours after the injury, if it
makes you more comfortable and supports your shoulder. If you feel you need to
use a sling for more than 48 hours, discuss your symptoms with your
doctor.

Elevate the injured or sore area on
pillows while applying ice and anytime you are sitting or lying down. Try to
keep the area at or above the level of your heart to help minimize
swelling.

Gently massage or rub the area to relieve pain and
encourage blood flow. Do not massage the injured area if it causes
pain.

Aspirin (also a nonsteroidal
anti-inflammatory drug), such as Bayer or Bufferin

Talk to your child's doctor before switching back and
forth between doses of acetaminophen and ibuprofen. When you switch between two
medicines, there is a chance your child will get too much medicine.

Safety tips

Be sure to follow these
safety tips when you use a nonprescription medicine:

Carefully read and follow all directions
on the medicine bottle and box.

Symptoms to watch for during home treatment

Shoulder range of motion or strength in the joint
decreases or does not return to normal.

Symptoms do not improve
despite home treatment.

Symptoms become more severe or
frequent.

Prevention

The following tips may prevent shoulder
problems or injuries.

General prevention tips

Stay in good overall physical shape. Strengthen
your wrist, arm, shoulder, neck, and back muscles to help protect and decrease
stress on your shoulder. Do stretching and range-of-motion (ROM) exercises for
your arms and shoulders.

Maintain good posture. Stand straight and
relaxed, without slumping.

Warm up well and stretch before any
activity. Stretch after exercise to keep hot muscles from shortening and
cramping.

Wear protective gear during sports or recreational
activities, such as roller-skating or soccer.

Wear your seat belt
when in a motor vehicle.

Do not use alcohol or other drugs before
participating in sports or when operating a motor vehicle or other
equipment.

Don't carry objects that are too
heavy. Make sure children and teenagers use school bags and
backpacks correctly.

Avoid catching falling objects.

Use a step
stool. Do not stand on chairs or other unsteady objects.

Use the
correct body movements or positions during activities, such as lifting, so that
you do not strain your shoulder. Do not lift objects that are too heavy for
you.

Avoid overusing your arm doing repeated movements that can
injure your
bursa or tendons. In daily routines or hobbies, think
about the activities in which you make repeated arm movements. Try alternating
hands during activities such as gardening, cooking, or playing musical
instruments. Use
rest, ice, compression, and elevation (RICE) for home
treatment.

Avoid keeping your arms out to the side or raised
overhead for long periods of time, such as when painting a ceiling. If you must
do these things, take frequent breaks, and use RICE for home treatment.

Consider consulting a sports-training specialist if you are a
competitive or serious recreational athlete. The specialist can recommend
training and conditioning programs to prevent shoulder problems or
injuries.

Make sure your child's backpack is the right size with
good support. Carrying heavy backpacks may increase the risk of shoulder
problems or injury.

If you feel that activities at your workplace
are causing pain or soreness from overuse, call your human resources department
for information on alternative ways of doing your job or to discuss equipment
modifications or other job assignments.

Reduce falls

Keep your bones strong

Eat healthy foods such as milk, cheese, yogurt,
and dark green, leafy vegetables like broccoli. For more information, see the
topic
Healthy Eating .

Exercise and stay active.
Talk to your doctor about an exercise program that is right for you. Begin
slowly, especially if you have been inactive. For more information, see the
topic
Fitness .

Don't drink more than 2 alcoholic
drinks a day if you are a man, or 1 alcoholic drink a day if you are a woman.
Drinking alcohol increases your chances of having weak bones (
osteoporosis). It also increases your chances of
falling.

Do not smoke or use other tobacco products. Smoking
increases your chances of having osteoporosis. It also causes problems with the
blood supply in your arms and slows healing. For more information, see the
topic
Quitting Smoking .

Possible abuse

Shoulder injuries such as bruises, burns,
fractures, cuts, or punctures may be caused by
abuse . Suspect possible abuse when an injury cannot be
explained or does not match the explanation, repeated injuries occur, or the
explanations for the cause of the injury change. You may be able to prevent
further abuse by reporting it and
seeking help .

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the
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